Pneumococcal sepsis with early immune dysregulation: results of selective LPS hemoperfusion (case report)

Pneumococcal infection (Streptococcus pneumoniae) remains one of the leading causes of severe communityacquired pneumonia and sepsis, which can rapidly lead to multiple organ failure and death even in individuals without significant comorbidities. A hallmark of severe sepsis is the early development of immune dysregulation with profound T-cell lymphopenia, which substantially worsens the prognosis. Modern intensive care, including extracorporeal blood purification when indicated, may contribute to a more favorable disease course. The article presents a clinical case of a 33-year-old patient without a relevant premorbid background, admitted to the St. Petersburg State Medical Institution “Clinical Infectious Diseases Hospital named after S.P. Botkin” with the diagnosis of Community-acquired pneumonia caused by Streptococcus pneumoniae, severe course, complicated by severe sepsis (SOFA >4).

1. Singer M. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) / M. Singer, C.S. Deutschman, C.W. Seymour, M. Shankar-Hari, D. Annane, M. Bauer, R. Bellomo, G.R. Bernard, J.D. Chiche, C.M. Coopersmith, R.S. Hotchkiss, M.M. Levy, J.C. Marshall, G.S. Martin, S.M. Opal, G.D. Rubenfeld, T. van der Poll, J.L. Vincent, D.C. Angus //jAMA. – 2016. – Vol. 315, No. 8. – P. 801-810.

2. Briko N.I. Pnevmokokkovaya infektsiya v Rossiyskoy Federatsii: sostoyanie problemy / N.I. Briko, V.A. Korshunov, K.S. Lomonosov // Vestnik RAMN. – 2021. – T. 76, No. 1. – S. 28-42. (In Russian)

3. Cheng L. Unveiling the research advances of sepsis: pathogenesis, precise intervention and clinical perspective / L. Cheng, Y. Cao, S. Liu, L. Lv, J. Zhang, J. Bao, G. Wang, P. Xu // Int. J. Surg. – 2025. – Vol. 111, No. 9. – P. 6260-6289.

4. Stepanov A.V. Immunnaya korrektsiya u patsientov s sepsisom (obzor literatury) / A.V. Stepanov, K.G. Shapovalov // Vestnik anesteziologii i reanimatologii. – 2024. – T. 21, No. 2. – S. 103-111. (In Russian)

5. Petrova M.V. Aspekty formirovaniya entsefalopatii i miokardiopatii pri sepsise / M.V. Petrova, A.V. Butrov, V.V. Kulabukhov, i dr. // Vestnik anesteziologii i reanimatologii. – 2023. – T. 20, No. 5. – S. 84-91. (In Russian)

6. Surovoy Yu.A. Sepsis-indutsirovannaya immunosupressiya / Yu.A. Surovoy, S.V. Tsarenko // Immunologiya. – 2019. – T. 40, No. 3. – S. 93-101. (In Russian)

7. Cavaillon J. Sepsis therapies: learning from 30 years of failure of translational research to propose new leads /j. Cavaillon, M. Singer, T. Skirecki // EMBO Mol. Med. – 2020. – Vol. 12. – P. EMMM201810128.

8. Gelfand B.R. (red.). Sepsis: klassifikatsiya, kliniko-diagnosticheskaya kontseptsiya i lechenie / pod red. akad. RAN B.R. Gel’fanda. – 4-e izd., dop. i pererab. – M.: OOO «Meditsinskoe informatsionnoe agentstvo», 2017. – 408 s. (In Russian)

9. Bovkun I.V. Opyt primeneniya selektivnoy LPS-sorbtsii v kompleksnoy terapii bol’nykh s gramotritsatel’nym sepsisom / I.V. Bovkun, E.G. Gavrilova, D.V. Sokolov, I.V. Shlyk // Vestnik anesteziologii i reanimatologii. – 2017. – T. 14, No. 3. – S. 68-73. (In Russian)

10. Masolitin S.V. Primenenie ranney selektivnoy gemoadsorbtsii na osnove sverkhsshitykh stirol divinilbenzol’nogo sopolimera u patsientov s rabdomiolizom toksicheskogo geneza, oslozhnennogo ostrym pochechnym povrezhdeniem (multsentrovoe randomizirovannoe klinicheskoe issledovanie) /s.V. Masolitin, D.N. Protsenko, I.N. Tyurin, M.A. Magomedov, T.G. Kim, L.A. Grishina, A.O. Bykov, E.B. Gelfand, O.V. Ignatenko // Obshchaya reanimatologiya. – 2022. – T. 18, No. 6. – S. 22-29. (In Russian)

11. Mavzyutova G.A. Osobennosti immunnykh narusheniy pri vnebol’nichnykh pnevmoniyakh / G.A. Mavzyutova, R.M. Fazlyeva, E.B. Tyurina, i dr. // Meditsinskaya immunologiya. – 2007. – T. 9, No. 6. – S. 605-612. (In Russian)

12. Potapova M.B. Immunologicheskie osobennosti fenotipov i endotipov sepsisa / M.B. Potapova, V.V. Zverev, M.A. Babaev, E.A. Bogdanova, O.O. Grin’, I.B. Semenova, E.A. Merem’yanina, O.A. Svitich // Meditsinskaya immunologiya. – 2026. – T. 28, No. 1. – S. 9-20. (In Russian)

13. Nikiforova Yu.G. Sravnitel’naya otsenka informativnosti opredeleniya prokal’tsitonina, S-reaktivnogo belka i kholesterina kak laboratornykh markerov sepsisa / Yu.G. Nikiforova, S.A. Tochilo, A.V. Marochkov // Vestnik anesteziologii i reanimatologii. – 2016. – T. 13, No. 1. – S. 47-52. (In Russian)

14. Delaney A. Current standard of care for septic shock / A. Delaney, M. Borges-Sa, M.S. Chew, J.J. De Waele, J. Dye, A.K. Khanna, O. Hamzaoui, N. Hammond, G. Hernandez, M. Herridge, J. Lipman, F.R. Machado, A. Mekontso Dessap, X. Monnet, S.N. Myatra, B. Venkatesh, D. De Backer // Intensive Care Med. – 2026. – Vol. 52, No. 1. – P. 89-103.

15. Rey S.I. Dinamika organnoy disfunktsii i markerov vospaleniya u patsientov s septicheskim shokom pri mul’tmodal’noy gemokorrektsii: mul’tsentrovoe, randomizirovannoe, kontroliruemoe issledovanie /s.I. Rey, V.V. Kulabukhov, A.Yu. Popov, O.V. Nikitina, G.A. Berdnikov, T.G. Kim, S.V. Masolitin, M.A. Magomedov, O.V. Ignatenko, N.P. Krotenko, A.N. Marysheva, N.I. Chaus, L.V. Okhinko, M.S. Mendibaev, A.G. Chumachenko, A.V. Grechko, V.M. Pisarev // Vestnik intensivnoy terapii imeni A.I. Saltanova. – 2023. – No. 4. – S. 60-71. (In Russian)

16. Cutuli S.L. Polymyxin B hemoperfusion in septic shock: systematic review and meta-analysis /s.L. Cutuli, M. Artigas, J. Fumagalli et al. // Blood Purification. – 2022. – Vol. 51. – P. 411–421.

17. Rachina S.A. Etiologiya vnebolnichnoy pnevmonii u vzroslykh v postpandemicheskiy period /s.A. Rachina, O.A. Kupryushina, D.A. Strelkova, S.N. Avdeev i dr. // Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. – 2024. – T. 26, № 2. – S. 141–150. (In Russian)

18. Sedanova A.V. Gemosorbenty: materialy, struktura i fiziko-khimicheskie svoystva. Obzor / A.V. Sedanova, N.V. Kornienko, L.G. Pyanova, M.S. Delyagina, A.V. Lavrenov //fizikokhimiya poverkhnosti i zashchita materialov. – 2024. – T. 60, № 6. – S. 561–588. (In Russian)

19. Avdeev S.N. Vnebolnichnaya pnevmoniya u vzroslykh. Klinicheskie rekomendatsii 2024 (kratkaya versiya) /s.N. Avdeev, A.V. Dekhnich, A.A. Zaytsev i dr. // Respiratornaya meditsina. – 2025. – T. 1, № 3. – S. 6–18. (In Russian)